Provider Demographics
NPI:1275167009
Name:MOLTER, PEGGY JOAN (MA LPC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JOAN
Last Name:MOLTER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1721
Mailing Address - Country:US
Mailing Address - Phone:517-438-8144
Mailing Address - Fax:517-438-8195
Practice Address - Street 1:1325 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1721
Practice Address - Country:US
Practice Address - Phone:517-438-8144
Practice Address - Fax:517-438-8195
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI640101157101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor